Healthcare Provider Details

I. General information

NPI: 1063934305
Provider Name (Legal Business Name): ELISABETH ESPINOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2017
Last Update Date: 07/27/2020
Certification Date: 07/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 E 3RD ST STE C
LOS ANGELES CA
90013-1630
US

IV. Provider business mailing address

470 E 3RD ST STE C
LOS ANGELES CA
90013-1630
US

V. Phone/Fax

Practice location:
  • Phone: 213-620-5712
  • Fax: 213-621-4155
Mailing address:
  • Phone: 213-620-5712
  • Fax: 213-621-4155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number78222
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number95782
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: